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Should I accept this kidney?
Author(s) -
Matas Arthur J,
Gillingham Kristen,
Payne William D,
Humar Abhinav,
Dunn David L,
Sutherland David Er,
Najarian John S
Publication year - 2000
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1034/j.1399-0012.2000.140117.x
Subject(s) - medicine , proportional hazards model , panel reactive antibody , kidney transplantation , surgery , kidney , kidney disease , intensive care medicine
Background. Transplant candidates frequently ask whether they should, based on information available at the time, accept a cadaver kidney or wait for a potentially better one.Methods. We analyzed 937 first and second cadaver transplants done between January 1, 1984 and December 31, 1997 to determine if information available at the time an offer is made could be used to predict long‐term graft survival.Results. By Cox regression, risk factors for worse long‐term graft survival were older donor age, cardiovascular or cerebrovascular cause of donor death, and delayed graft function (DGF). HLA‐ABDR mismatch was marginally significant. Whether DGF will occur is not known at the time of an offer, but risk factors can be determined; we found these to be older donor age and> 10% panel‐reactive antibodies (PRA) at transplantation (by Cox regression). Using these variables (PRA, ABDR mismatch, donor age, and donor cause of death) known at the time of an offer, we calculated the relative risk of worse long‐term graft survival for each subgroup ( Table 3 in manuscript). In general, older age and donor death from cardiovascular or cerebrovascular disease were associated with worse outcome. Kidneys from donors of <50 yr had the best outcome, irrespective of match.Conclusion. The data provided can be used to help guide patients as to whether they are better off accepting an offered kidney or waiting for a potentially better one. If an offer is declined, the next kidney may have a potentially worse outcome. 3 Relative risk for worse or poor long‐term graft survival, based on information known at the time of a kidney offerDonor 18–50 yr, other cause of death Donor 18–50 yr, CVD cause of death Donor ≥50 yr, other cause of death Donor ≥50 yr, CVD cause of death Tx PRA (%) ABDR mm (n) RR Rank RR Rank RR Rank RR Rank0 0 1 1 1.16 3 1.28 6 2.26 25 0 1–6 1.19 4 1.38 10 1.52 14 2.69 27 1–10 0 1.21 5 1.41 11 1.55 17 2.74 28 1–10 1–6 1.44 13 1.67 19 1.84 23 3.25 31 11–75 0 1.12 2 1.30 7 1.43 12 2.53 26 11–75 1–6 1.33 9 1.54 16 1.70 21 3.01 30 76–100 0 1.32 8 1.54 15 1.69 20 3.00 29 76–100 1–6 1.57 18 1.82 22 2.01 24 3.55 32CVD, cerebrovascular or cardiovascular disease; Tx, transplant; PRA, panel‐reactive antibody; mm, mismatch; RR, relative risk.